It started with the hardest of conversations: when a physician must tell a patient or family difficult news.
The OHSU Center for Ethics in Health Care, which gained national prominence through policy and practice improvements to end-of-life care, launched communication skills testing with OHSU School of Medicine students in 2018. Trained physicians teach medical students how to share a difficult diagnosis or prognosis with clear, simple, kind and respectful language and without confusing medical jargon and how to honestly disclose a medical error.
This past year, the center expanded to trainings around respectful communication with patients who live with a disability. And now the center will broaden the concept of compassionate communication as a cornerstone of all medical practice, especially essential for patients in underserved communities where distrust or fear of health care impedes access and outcomes.
The center’s expansion will be led by Cliff Coleman, M.D., M.P.H., associate professor of family medicine, OHSU School of Medicine, who is nationally recognized in the field of health literacy and in research to develop core health literacy competencies for health professionals. Coleman becomes the first recipient of the Doris and Mark Storms Chair in Compassionate Communication, made possible by the Storms Family Foundation, in the OHSU Center for Ethics in Health Care, effective July 1.
“Health information is almost always unnecessarily complicated,” said Coleman. “That makes it hard to understand, hard to judge, and hard to act on. This is bad for patients, and not just for those who happen to have less education or lower health literacy. Compassionate communication starts with making information as easy to understand as possible for everyone. But this means changing the way we train healthcare professionals to communicate and interact with people. Without this we’re failing our patients and society.”
Coleman brings with him not only his research and training but his experience as a physician at a Federally Qualified Health Center (OHSU Family Medicine at Richmond) and as a thread leader for the first 18 months of ethics, professionalism and communications skills in the medical school, said Susan Tolle, M.D., professor of medicine and director of the OHSU Center for Ethics in Health Care. (View the OHSU Health Equity Symposium featuring Dr. Coleman’s “Health Literacy and Systemic Racism: Redressing Oppression through Clear Health Communication.”)
“Compassionate communication is foundational to every patient interaction,” said Tolle. “If people feel demeaned, dismissed or humiliated, if they feel embarrassed, for example, because they struggle with their weight, all of these things can impact their ability to be a partner in their care and to heal. We could not be more delighted to welcome Dr. Coleman to this new and vitally important role.”
Ian Jaquiss, J.D., OHSU interim Americans with Disabilities Act coordinator, explained the value of this work. Jaquiss, who suffered a spinal cord injury when he was 2 and uses a wheel chair for mobility, has experienced and advocated for others who have experienced bias in health care – from exam rooms lacking accommodation for patients unable to get up on the exam table to doctors cracking jokes about a person’s paralysis -- “You should be happy you can’t feel this, because otherwise it would hurt like hell.” -- to clinicians not treating the patient as a full person.
“If I’m not being treated for my spinal cord injury, the fact that I have a spinal cord injury shouldn’t matter or be the focus of my conversation with the doctor; it’s the person that matters,” Jaquiss said.
Last fall, Jaquiss took part in a Center for Ethics video modeling a positive physician-patient relationship for individuals living with a disability. In the video, Jaquiss plays a person with end-stage cancer (though he does not actually have cancer); the provider draws him out about his activities and values, allowing him to define who he is and the provider to tailor his care to support that.
“I tried everything I could think of to get out of doing the video,” said Jaquiss, not one for self-promotion. “But I’m glad I did it. If there is a chance that those bad interactions won’t happen as often, that gives me hope. Proper, respectful communication goes a long way toward making a patient feel like the provider views them as worthy of receiving care.”